Provider Information for 1578880829
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WANDA LYNN GRANT LPC
Sex: Female
NPI: 1578880829
Last Updated: 2011-03-23
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
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| NPI | 1578880829 | ||||||||||||
| Enumeration Date | 2010-04-27 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 28972 HWY 43 ALBANY, LA 70711 United States Phone: 225-567-6886 | Fax:225-567-6828 | ||||||||||||
| Primary Practice Address | 28972 HWY 43 ALBANY, LA 70711 United States Phone: 225-567-6886 | Fax:225-567-6828 | ||||||||||||
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